[Epidemiology of illnesses and musculoskeletal disorders in grocery stores and catering]. / Epidemiologia delle malattie e dei disturbi muscoloscheletrici nella grande distribuzione e nella ristorazione collettiva.

Large scale retail industry and catering industry are characterized by the widespread presence of several risk factors of work-related musculoskeletal disorders (WMSD): repetitive movements, incongruous postures and manual handling tasks. We reviewed current epidemiological evidence related to musculoskeletal disorders within these two sectors, distinguishing between symptoms and clinically documented disorders. In retail industry cashier is the most investigated figure, regarding upper limbs disorders as a consequence of repetitive tasks. In the catering sector there are few studies, mostly focused only on the job as a cook. The majority of studies showed a high prevalence of WMSD and, to a lesser extent, a high frequency ofmusculoskeletal alterations; suggesting the presence of a not negligible risk. These findings, however, are affected by a number of methodological limitations: they derive from cross-sectional studies, are based on voluntary self-selected workers, are focused on not unequivocally defined health outcomes, and are usually lacking a proper comparison. with the prevalence in less exposed/reference working groups. In order to achieve an effective control of the workers' risk, it is therefore necessary to design and conduct prospective studies that compare the risk of developing disorders and/or diseases in workers exposed to different levels of biomechanical load. It appears essential to involve occupational physicians in active health surveillance programs in order to identify critical areas and to develop effective preventive measures.

[Ergonomics and productivity: an example applied to a manufacturing industry]. / Ergonomia e produttività: un esempio applicato ad una industria manifatturiera.

BACKGROUND: The survival of manufacturing in the western world also depends on the ability to increase productivity. To achieve this goal, it is necessary to recover the efficiency of all workers suffering from upper limb biomechanical overload disease. Ergonomic methods can be a valuable tool in solving this apparent conflict: operatives'productivity and health. METHODS: After carrying out an ergonomic education and training programme for all company employees and risk assessment for upper limb biomechanical overload through the OCRA checklist method, a programme of improvements on a production line was planned and tested, mainly based on international and European standards. RESULTS: Within approximately 2 years, thanks to changes in workplace layout and organization, a significant reduction of 22.7% in risk level was achieved and, at the same time, a 16% increase in productivity. DISCUSSION: An ergonomic approach based on global, interdisciplinary and participatory principles in the case considered showed that it is possible to match increased productivity with decreased risk. In this specific case application of ergonomic principles during product design was rather poor, which is typical of companies working for third party customers.

[Preliminary results of a health survey of muscular-skeletal disorders in a group of 2247 small building trades in the Province of Bergamo]. / Primi risultati di un'indagine sanitaria sui disturbi muscolo-scheletrici in un gruppo di 2247 artigiani edili nella provincia di Bergamo.

BACKGROUND: In the past ten years European and Italian statistics reported a significant increase in work-related musculoskeletal disorders, which also covered the construction industry. OBJECTIVES: To verify this issue, the EPM Research Unit, in collaboration with the Small Craft Industries Territorial Joint Committee in Bergamo (CPTA), undertook a research project on muscular-skeletal disorders with special reference to the lumbar spine and upper limbs. METHODS: The health survey was carried out by an ad hoc trained staff RESULTS: Between November 2009 and July 2010, data on 2247 subjects doing a variety of jobs were obtained, more than 50% of whom were masons. The entire sample and the group of masons were investigated and both exhibited a prevalence of upper limb disorders that was definitely higher than in the reference group of non-exposed subjects. Regarding the lumbar spine, the most significant evidence was the high prevalence of degenerative diseases (herniated disc), while subjective disorders appeared to be lower than in the reference groups. These data are influenced by the healthy worker effect, which is extremely marked in this industrial sector, as well as by the economic crisis that led to many workers having to leave. CONCLUSIONS: Active research needs to be included in the protocol of health surveillance (with appropriate clinical protocol), of upper limb and spinal MSDs. The data also highlight the need for biomechanical overload exposure data aimed at reconstructing risk profiles (from biomechanical overload)for each job and at simplifying risk assessment requirements according to present legislation but above all at identifying the technological and organizational solutions to eliminate this particular risk.

[Epidemiological study of UL-WMSDs in 2022 VDU workers]. / Indagine epidemiologica sulle patologie e sui disturbi muscoloscheletrici degli arti superiori in un gruppo di 2022 videoterminalisti.

BACKGROUND: The literature dealing with the health effects of VDU work identified right from the beginning a group of MSDs, mainly affecting the cervicobrachial region, so that VDU work could be considered a risk factor due to biomechanical overload of the upper limbs, OBJECTIVES: The aim of the study was to assess the prevalence of symptoms and diseases of VDU workers. METHODS: A cohort of 2022 workers (1125 males and 897 females) working at VDUs for a duration of time equal to or exceeding 20 hours per week, including insurance and bank employees (no desk activity), was submitted to clinical and functional assessment of the cervical spine and upper limbs following a structured protocol (case history, clinical and instrumental examinations), as used by occupational physicians, in order to identify "anamnestic cases" and diagnose upper limb biomechanical overload diseases. Besides medical data, a series of data was also collected in order to obtain details of the work task: time schedule, duration of VDU use, organizational autonomy, data entry method. RESULTS: The prevalence of subjects with UL-WMSDs was 1.9% for males and 5.8% for females, and basically similar to that found in non-exposed working populations. However, there did seem to be a correlation between cervical disorders and computer use, only for females. CONCLUSIONS: In the sample studied no association was shown between VDU work and onset of upper limb diseases, which was confirmed even considering the different exposure variables. Analysis of"anamnestic cases" made by comparison with non-exposed populations, confirmed the lack of association between upper limb diseases and VDU work.

Digestive endoscopy and risk of upper limb biomechanical overload.

BACKGROUND: For several years the literature has reported a high prevalence of upper limb musculoskeletal disorders among medical staff carrying out digestive endoscopy. OBJECTIVES: The EPM research unit, in cooperation with the Italian Society of Digestive Endoscopy (SIED) and with the patronage of the Italian Society of Ergonomics (SIE), undertook research that would permit assessment of upper limb biomechanical overload using the OCRA method during gastroscopy and colonoscopy and, via a pilot study, collect health data on 179 workers employed in endoscopy services. RESULTS: Risk analysis showed slight exposure levels for the arm bearing the instrument and a medium-to-high exposure for the other arm. However, the study of diseases in this sample showed a higher prevalence than in the reference population not exposed to risk for the upper limbs and in particular in the hand-wrist area. CONCLUSIONS: Risk analysis highlighted possible ergonomic measures that would be easy to implement and which would significantly reduce the risk.

Immunomodulatory effects of the herbicide propanil on cytokine production in humans: In vivo and in vitro exposure.

Propanil, 3,4-dichloropropionanilide, a commonly used herbicide, has been shown to induce effects on the mouse immune system. The aim of this study was to assess the immunotoxicity of propanil in occupationally exposed agricultural workers and to characterize its molecular mechanism of action. Seven agricultural workers intermittently exposed to propanil and 7 healthy matched controls entered the study. Data were collected through physical examination, and laboratory investigations addressed at the main serum, cellular, and functional immune parameters. The levels of exposure were assessed by determining the urine concentration of the major propanil metabolite, 3,4-dichloroaniline. The investigation of serum, cellular, and functional immune parameters suggested that propanil exposure results in a modest immunomodulatory effect, characterized by an increase in the plasma level of IgG(1) and in LPS-induced IL-6 release and, by a reduction in PHA-induced IL-10 and IFN release, associated with a reduced IFN/IL-4 ratio. As observed, following in vivo exposure, in vitro treatment of human peripheral blood leukocytes with propanil resulted in a dose-dependent reduction in PHA-induced IFN-gamma and IL-10 production, while LPS-induced TNF-alpha production was not affected indicating a direct effect of propanil on selected immune parameters. We demonstrated that propanil interfering with PHA-induced intracellular calcium increase modulated IL-10 and IFN-gamma transcription and translation, which indicates that propanil acts on early events triggered by PHA. Overall, our results suggest that human exposure to propanil has slight immunomodulatory effects, and point out that the inhibition of the PHA-induced intracellular calcium rise is an important target of propanil. These findings improve our understanding of the mechanism underlying propanil-induced immunotoxicity.

[A particular case of hard metal disease]. / Un "particolare" caso di patologia da metalli duri.

BACKGROUND: The production and the use of hard metal tools have becoming increasingly widespread since the second half of the last century also thanks to the great variety of applications that extends from DIY to the aeronautical industry. It has already been known for many years that occupational exposure to hard metals dusts (which occurs especially in people employed in production of the metals or in the sharpening of tools that contain them) can determine the onset of pulmonary fibrosis, bronchial asthma and contact dermatitis. OBJECTIVES: clinical evaluation of a peculiar case of hard metal disease. Descriptions of cases with single pathological pictures due to hard metals, are, in fact, common in the literature, neither are cases with two different clinical pictures (more frequently asthma and pulmonary fibrosis) rare. However, cases in which all the signs and symptoms appeared simultaneously have never been reported. METHODS: a male worker aged 41 years, employed i a hard metal factory for seven years in sintering, and then in grinding. A year later he developed dry cough, wheeze, and eczematous patches. The diagnosis of hard metal disease was based on the work-related symptoms, clinical evaluation, spirometry, chest x-ray, HRCT and patch tests. RESULTS: during the working period, ventilatory function decreased substantially, and then normalized one month after the patient stopped working. Patch tests confirmed sensitivity to cobalt, and skin lesions improved, as did ventilatory function. Chest x-ray and HRCT showed a pulmonary fibrosis that, at the last radiological examination, was still unchanged. CONCLUSIONS: The particular susceptibility to the development of the diseases, could, in our opinion, be in relationship with the race of the subject, many studies (particularly American) have shown that allergic diseases are more frequent, and often more serious, in African subjects, particularly in immigrants from Africa. In the case of occupational diseases attention also needs to be given to the fact that immigrants are often employed in duties that involve a greater exposure to harmful or sensitizing agents. The occurrence of a whole series of occupational allergic diseases among these workers is therefore to be expected.